The fifth report of the Shipman Inquiry was published
in December last year, and the debate it has initiated in
theUKstill continues. It is likely to reverberate around
the panelled meeting rooms of Britain’s medical colleges
and associations for years to come. But is this a
purely British affair, or do recommendations of the
chair of the inquiry, Dame Janet Smith, have messages
for doctors in other countries? An investigation of the
circumstances that allowed an inexplicably deranged
lone medical serial killer to remain undetected over a
period of more than 20 years in a country with a very
atypical healthcare system may seem of very little
relevance to leaders of doctors in Paris, Canberra or
Washington. However, the inquiry’s report addresses
several fundamental principles of medical professionalism,
and the findings are important for doctors’
leaders everywhere.

The report contains recommendations for improvements
to patient complaint systems, methods
of monitoring, managing and disciplining general
practitioners, and for reforming the system of medical
regulation. While these detailed recommendations
may be of some interest in other countries, the most
important issue does not lie in the recommendations,
but in the central charge made against the medical
profession and its regulating body, the General Medical
Council (GMC). The workings of the GMC have
been subjected to the closest examination, and the
verdict is that it, and therefore the profession it regulates,
has tended to place the interests of doctors before
the interests of patients. The GMC put ‘being fair to
doctors’ ahead of protecting patients, and despite
several changes implemented by the GMC in recent
years including a revised constitution and the introduction
of revalidation, the old culture lingers on.
Within the profession, many doctors perceive the purpose
of theGMC as being to represent them. They had
not fully understood that its purpose was to regulate
them.

The verdict that doctors have sometimes placed
their own interests before those of patientswill be hard
for some doctors to accept. But anyone who studies
the inquiry’s report – all 1200 pages – and reviews a
sample of the transcripts of the hearings that are available on a website (www.the-shipman-inquiry.org.uk) could
not fail to come to the same conclusion. A more
damning verdict on the profession is hard to imagine,
and doctors in Britain must accept it and decide what
changes they must make to eliminate the problem.
Doctors in other countries must ask whether their
own profession shares the same flaw, and if so must act
urgently and decisively.

The attitudes (or culture) of the medical profession
have for several decades been studied by sociologists
but it is difficult to claim that the findings have influenced
the profession to any extent. The researchers of
quality improvement in healthcare may have noted
the work of the sociologists but they have generally
avoided exploring theway themedicalprofession makes
its decisions. The profession’s colleges and associations
where decisions are debated and which provide leadership
have been neglected by researchers, and the
time has come to correct this oversight. The colleges in
the UK need to promote or commission research to
help them better understand the culture they foster,
how their decisions come to be made, and to what
extent andwhy they have in the past sometimes favoured
the interests of doctors over those of patients. Colleges
and associations in other countries should consider
doing the same. At the very least, they should study the
findings of such research in the UK and resist the
natural reactions of ‘It is not like that here’ and ‘That
could not happen here’.

The limited participation of patient representatives
in the functioning of the medical colleges and associations
is almost certainly a key reason why the interests
of patients have not always come first. In the last
20 years, the medical profession in the UK has been
distracted by a relentless flood of health service restructuring
and reform, from concentrating on the
interests of patients. Too much time has been spent on
responding to the latest policy initiative and too little
on the familiar needs of patients. This must change.
The reorientation of colleges and associations away
from an almost total preoccupation with policy, to
focus on the interests of patients will take time, and
will not occur without the involvement of patients in
various ways, including representation, focus groups, citizen’s panels or surveys. When better informed
about the interests of patients, colleges and associations
will be better able to educate their members
about their responsibilities – and will be better placed
to negotiate with policy makers. For other countries
the message is clear; stay in touch with patients and
their interests. This will give you your purpose.

Leadership is fundamental. In the UK, the multiplicity
of colleges and associations that share to variable
degrees the task of representing doctors has failed
to provide adequate leadership. In consequence the
profession has lacked direction and has a relatively weak
sense of professionalism. Strong leadership is needed
to produce a strong profession. Leadership that can
instruct doctors to act against their own interests in
order to protect their patients – to do what is right
rather than what is comfortable – will in due course instil a strong sense of professional values. Strong
leadership requires reform of the bodies that currently
govern the profession. The various colleges and associations
need to consider how to restructure themselves
for the 21st century. Doctors in other countries
should take a long, cold look at their treasured colleges
and associations and ask whether they meet the needs
of today’s medical practice and today’s patients.

Select your language of interest to view the total content in your interested language